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Talhout R, Leventhal AM. Coolants, organic acids, flavourings and other additives that facilitate inhalation of tobacco and nicotine products: implications for regulation. Tob Control 2024:tc-2024-058738. [PMID: 39256038 DOI: 10.1136/tc-2024-058738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 08/19/2024] [Indexed: 09/12/2024]
Abstract
To inform regulatory policy, this article summarises findings on inhalation facilitation from the ninth report of the WHO Study Group on Tobacco Product Regulation. Some additives counteract the harshness and bitterness of tobacco and nicotine product aerosols, making them easier to inhale. Additives that promote inhalability may perpetuate and increase the use of inhaled tobacco and nicotine products, especially by young people. Thus, as a class, additives that facilitate inhalation are an important regulatory target to prevent tobacco and nicotine product uptake. We defined inhalation facilitation as modifications to products during manufacturing that enhance the sensory experience and (potentially) behaviours associated with inhalation (eg, deeper puffs, faster inhalation, larger puff volume, shorter intervals in between puffs and use episodes). Evidence review showed that: (a) menthol and synthetic coolants decrease irritation caused by aerosol constituents by activating sensory perception receptors (eg, cooling receptors) and may promote dependence in inexperienced users; (b) acid additives and sugars, which lower the pH of aerosols and shift nicotine from free-base to protonated salt forms, reduce harshness and increase blood nicotine yield; (c) e-cigarette flavourings perceived as sweet or fruity reduce subjective bitterness, increase attractiveness and may escalate use, although their effects on perceived harshness are inconclusive; (d) sugars in tobacco impart sweet sensations, but limited industry-independent data preclude strong conclusions for sugars' roles in inhalation facilitation. Given these findings, WHO policy recommendations suggest that regulators might consider banning ingredients that facilitate inhalation in all commercial inhaled tobacco and nicotine products.
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Affiliation(s)
- Reinskje Talhout
- Centre for Health Protection, Dutch National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Adam M Leventhal
- Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
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2
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Barrington-Trimis JL, Stoolmiller M, Vogel EA, Harlow A, Tackett AP, Unger JB, McConnell R, Leventhal AM, Audrain-McGovern J, Sargent JD. Recall of Flavor at First E-cigarette Use and Its Association with E-cigarette Progression: The Mediating Effects of First Sensory Experience. J Pediatr 2024; 275:114246. [PMID: 39154739 DOI: 10.1016/j.jpeds.2024.114246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 08/05/2024] [Accepted: 08/12/2024] [Indexed: 08/20/2024]
Abstract
OBJECTIVE To test whether the association between flavor at first vape and continued use is mediated through subjective experience at first vape. STUDY DESIGN In a 2020 cross-sectional survey, 955 young adult ever-vapers recalled their first flavor vaped, subjective experiences at first use, current vaping behavior, nicotine dependence, and quit attempts. A latent class model grouped first-use subjective experiences into classes. Two-part negative binomial hurdle models for each vaping behavior evaluated whether the association of first flavor used with vaping outcomes was mediated by positive experience. RESULTS Four latent classes (positive, positive and negative, negative, and minimal experience) were further reduced to "any positive experience" (only positive, positive and negative) vs "no positive experience" (negative or minimal). Class membership mediated the association of first flavor used (mint/menthol/ice [ie, "cooling"] or sweet vs other) with each vaping outcome. For example, cooling flavor (vs. other) was associated with positive class membership (OR = 3.5; 95% CI: 1.5, 8.1), which was then associated with any past 30-day vaping (OR = 3.9; 95% CI: 2.7, 5.8) and greater number of vaping days among current vapers (RR = 1.9; 95% CI: 1.3, 2.7) in the two-part hurdle model. Similar results were observed for nicotine dependence and quit attempts, and for sweet (vs other) flavor for any dependence or quit attempts, but not number of dependence symptoms or quit attempts. CONCLUSIONS Use of a cooling or sweet flavor at first use was associated with having a positive first vaping sensory experience, and then greater likelihood as a young adult of reporting past 30-day vaping, more vaping days, and greater risk for nicotine dependence, suggesting a key mediating role of first use experience.
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Affiliation(s)
- Jessica L Barrington-Trimis
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA; Institute for Addiction Science, University of Southern California, Los Angeles, CA.
| | - Mike Stoolmiller
- Boston University, Wheelock College of Education and Human Development, Boston, MA
| | - Erin A Vogel
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Alyssa Harlow
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA; Institute for Addiction Science, University of Southern California, Los Angeles, CA
| | - Alayna P Tackett
- The Center for Tobacco Research, The James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Jennifer B Unger
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA; Institute for Addiction Science, University of Southern California, Los Angeles, CA
| | - Rob McConnell
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Adam M Leventhal
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA; Institute for Addiction Science, University of Southern California, Los Angeles, CA
| | - Janet Audrain-McGovern
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - James D Sargent
- Department of Biomedical Data Sciences, C. Everett Koop Institute at Dartmouth, Geisel School of Medicine, Hanover, NH
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3
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Sommer N, Franzen K, Andreas S, Pankow W, Kunstmann W, Hanewinkel R. [Harmful health effects of flavors in e-cigarettes]. Laryngorhinootologie 2024. [PMID: 38996433 DOI: 10.1055/a-2341-0544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2024]
Abstract
BACKGROUND Almost all e-cigarettes contain flavorings that make the product more attractive. In the evaluation of e-cigarettes on health, flavors have so far played a subordinate role. METHOD Selective literature search in PubMed, supplemented by legal regulations on the use of flavors in e-cigarettes. RESULTS Flavors make it easier to start using e-cigarettes and have a consumption-promoting effect. Deeper inhalation increases nicotine uptake and the absorption of toxic substances from the e-cigarette liquid. For some flavors, pathological effects have been demonstrated in addition to other toxic components of the e-cigarette. To date, no toxicological analyses are available for the vast majority of flavors contained in e-cigarettes. CONCLUSIONS The proven consumption-promoting effect and the health risks that can be extrapolated from preclinical data are significant for the political discussion of a ban on flavors for e-cigarettes, analogous to the ban on flavors in tobacco products already in force.
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Affiliation(s)
- Natascha Sommer
- Medizinische Klinik II, Excellence Cluster Cardio-Pulmonary Institute (CPI), Universities of Giessen and Marburg Lung Center (UGMLC), Mitglied des Deutschen Zentrums für Lungenforschung (DZL), Justus-Liebig-Universität Gießen
| | - Klaas Franzen
- Universitätsklinikum Schleswig-Holstein, Medizinische Klinik III, Pneumologie, Campus Lübeck, Airway Research Center North (ARCN), Deutsches Zentrum für Lungenforschung (DZL), Lübeck/Großhansdorf
| | - Stefan Andreas
- Lungenfachklinik Immenhausen, Immenhausen, Klinik für Kardiologie und Pneumologie, Universitätsmedizin Göttingen, Deutsches Zentrum für Lungenforschung
| | - Wulf Pankow
- Philipps-Universität Marburg - Fachbereich Medizin
| | - Wilfried Kunstmann
- IFT-Nord gGmbH, Institut für Therapie- und Gesundheitsforschung, Kiel, Deutschland
| | - Reiner Hanewinkel
- IFT-Nord gGmbH, Institut für Therapie- und Gesundheitsforschung, Kiel, Deutschland
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4
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Hardie L, McCool J, Freeman B. Industry response to New Zealand's vaping regulations. Tob Control 2024:tc-2023-058427. [PMID: 38429101 DOI: 10.1136/tc-2023-058427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 02/20/2024] [Indexed: 03/03/2024]
Affiliation(s)
- Lucy Hardie
- The University of Auckland, Faculty of Medical & Health Sciences, Auckland, New Zealand
| | - Judith McCool
- The University of Auckland, Faculty of Medical & Health Sciences, Auckland, New Zealand
| | - Becky Freeman
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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Walker-Franklin I, Onyenwoke RU, Leung T, Huang X, Shipman JG, Kovach A, Sivaraman V. GC/HRMS Analysis of E-Liquids Complements In Vivo Modeling Methods and can Help to Predict Toxicity. ACS OMEGA 2024; 9:26641-26650. [PMID: 38911720 PMCID: PMC11191570 DOI: 10.1021/acsomega.4c03416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/23/2024] [Accepted: 05/27/2024] [Indexed: 06/25/2024]
Abstract
Tobacco smoking is a major risk factor for disease development, with the user inhaling various chemicals known to be toxic. However, many of these chemicals are absent before tobacco is "burned". Similar, detailed data have only more recently being reported for the e-cigarette with regards to chemicals present before and after the e-liquid is "vaped." Here, zebrafish were dosed with vaped e-liquids, while C57-BL/6J mice were vaped using nose-cone only administration. Preliminary assessments were made using e-liquids and GC/HRMS to identify chemical signatures that differ between unvaped/vaped and flavored/unflavored samples. Oxidative stress and inflammatory immune cell response assays were then performed using our in vivo models. Chemical signatures differed, e.g., between unvaped/vaped samples and also between unflavored/flavored e-liquids, with known chemical irritants upregulated in vaped and unvaped flavored e-liquids compared with unflavored e-liquids. However, when possible respiratory irritants were evaluated, these agents were predominantly present in only the vaped e-liquid. Both oxidative stress and inflammatory responses were induced by a menthol-flavored but not a tobacco-flavored e-liquid. Thus, chemical signatures differ between unvaped versus vaped e-liquid samples and also between unflavored versus flavored e-liquids. These flavors also likely play a significant role in the variability of e-liquid characteristics, e.g., pro-inflammatory and/or cytotoxic responses.
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Affiliation(s)
| | - Rob U. Onyenwoke
- Department
of Biological & Biomedical Sciences, North Carolina Central University, Durham, North Carolina 27707, United States
- Biomanufacturing
Research Institute and Technology Enterprise (BRITE), North Carolina Central University, Durham, North Carolina 27707, United States
| | - TinChung Leung
- Department
of Biological & Biomedical Sciences, North Carolina Central University, Durham, North Carolina 27707, United States
- The
Julius L. Chambers Biomedical/Biotechnology Research Institute, North Carolina Central University, North Carolina
Research Campus, Kannapolis, North Carolina 28081, United States
| | - Xiaoyan Huang
- The
Julius L. Chambers Biomedical/Biotechnology Research Institute, North Carolina Central University, North Carolina
Research Campus, Kannapolis, North Carolina 28081, United States
| | - Jeffrey G. Shipman
- Department
of Biological & Biomedical Sciences, North Carolina Central University, Durham, North Carolina 27707, United States
| | - Alex Kovach
- RTI
International, Research
Triangle Park, North Carolina 27704, United States
| | - Vijay Sivaraman
- Department
of Biological & Biomedical Sciences, North Carolina Central University, Durham, North Carolina 27707, United States
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East K, Vu G, Sun T, D'Mello K, Perman-Howe PR, Taylor E, Nottage M, Brose LS, Robson D, McNeill A. Harm perceptions across vaping product features: An on-line cross-sectional survey of adults who smoke and/or vape in the United Kingdom. Addiction 2024. [PMID: 38839597 DOI: 10.1111/add.16572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 05/01/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND AND AIMS Vaping products are diverse with a wide variety of features, and popular products change rapidly. This study examined the features and types of vaping products that people who smoke and/or vape perceive contribute to the health harms of vaping. DESIGN, SETTING AND PARTICIPANTS This was a cross-sectional survey co-designed with adults who smoked/vaped and pre-registered. An on-line survey (November 2022) was used of a convenience sample of adults in the United Kingdom who smoked and/or vaped (n = 494). MEASUREMENTS As primary outcomes, respondents were asked to select any of 15 vaping product features they perceived might have any effect on the health harms of vaping (for each: selected, not selected). Independent variables were smoking/vaping status (smoke and vape; vape, formerly smoked; vape, never regularly smoked; smoke, do not currently vape); relative vaping harm perceptions [less harmful than smoking (accurate), equally/more harmful than smoking or do not know/refused (other)]. Binary logistic regressions were used to compare outcomes by current vaping/smoking status and relative harm perceptions, adjusting for age and sex. FINDINGS Most people (54.7%) selected between one and three features. The most frequently selected were nicotine concentration (62.2%) and amount of e-liquid consumed (59.1%), followed by nicotine type (e.g. salt or freebase; 33.0%), source/purchase location (25.3%), flavours (24.7%), temperature to heat e-liquid (21.1%), heat produced by device (20.9%), e-liquid brand (20.9%), amount of emissions (18.6%), device type (e.g. disposable, pod, tank; 17.2%), material of tank (17.0%), power/wattage (13.0%), device brand (8.1%), device size (4.1%) and device weight (2.4%). Higher nicotine concentrations, more e-liquid and salt (versus freebase) nicotine were perceived to confer greater harms. Disposables were perceived as slightly more harmful than reusable devices. There were few differences by current vaping/smoking status and between those with accurate (versus other) harm perceptions of vaping relative to smoking (P > 0.05 for most contrasts, adjusting for age and sex). CONCLUSIONS Certain features and types of vaping products [higher nicotine concentrations, more e-liquid consumed and salt (versus freebase) nicotine] were perceived to confer greater health harms among a sample of UK adults who smoked and/or vaped. Findings are consistent with pervasive misperceptions that nicotine is a major cause of harm, although e-liquid volume is likely to contribute to harms.
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Affiliation(s)
- Katherine East
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Giang Vu
- National Centre for Youth Substance Use Research, University of Queensland, St Lucia, Queensland, Australia
| | - Tianze Sun
- National Centre for Youth Substance Use Research, University of Queensland, St Lucia, Queensland, Australia
| | - Kimberly D'Mello
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Parvati Rose Perman-Howe
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Sheffield Centre for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Eve Taylor
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Matilda Nottage
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Leonie Sarah Brose
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Deborah Robson
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ann McNeill
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Jenkins C, Powrie F, Morgan J, Kelso C. Labelling and composition of contraband electronic cigarettes: Analysis of products from Australia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 128:104466. [PMID: 38796928 DOI: 10.1016/j.drugpo.2024.104466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 05/13/2024] [Accepted: 05/17/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND The sale of nicotine-containing electronic cigarettes (e-cigarettes) is prescription only in Australia, regulated under the Standard for Nicotine Vaping Products (TGO110). Australian e-cigarette users, however, are purchasing e-cigarette products outside of the intended pathways. METHODS The labelling of e-cigarette packaging (N = 388 boxes) and the chemical composition of disposable e-cigarettes and pods (N = 428) were analysed for adherence to the current Australian regulations. These samples were confiscated from over-the-counter retailers in NSW by the NSW Ministry of Health during 2022 for non-compliance with Australian regulations. RESULTS Following the announcement of the prescription only model for nicotine-containing e-cigarettes in Australia in mid-2021 there was a clear shift in the labelling of products. Any mention of the word 'nicotine' was removed from e-cigarette packaging by early 2022 and nicotine warnings were replaced with generic underage sale warnings. Despite this labelling, the vast majority (98.8 %) of devices analysed contained nicotine, most (89 %) at high concentration (>30 mg/mL) and 4.2 % contained at least one chemical prohibited by the TGO110. CONCLUSIONS It appears that manufacturers have removed any mention of nicotine from the original packaging of nicotine-containing disposable e-cigarettes to circumvent restrictions on nicotine-containing products and continue their sale. The packaging of e-cigarette products in Australia is generally not indicative of their contents, particularly nicotine, and most did not display required warnings. Ingredients with associated health risks, prohibited in legal vapes by the TGO110, were found in samples. Consequently, the risks of e-cigarette use cannot be appropriately identified from the information supplied on the packaging or device.
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Affiliation(s)
- Caitlin Jenkins
- Molecular Horizons, University of Wollongong, Wollongong, 2522 NSW, Australia; School of Chemistry and Molecular Bioscience, University of Wollongong, Wollongong, 2522 NSW, Australia
| | - Fraser Powrie
- NSW Ministry of Health, Centre for Population Health, Tobacco & E-cigarette Control Unit, 2065 NSW, Australia
| | - Jody Morgan
- Molecular Horizons, University of Wollongong, Wollongong, 2522 NSW, Australia; School of Chemistry and Molecular Bioscience, University of Wollongong, Wollongong, 2522 NSW, Australia
| | - Celine Kelso
- Molecular Horizons, University of Wollongong, Wollongong, 2522 NSW, Australia; School of Chemistry and Molecular Bioscience, University of Wollongong, Wollongong, 2522 NSW, Australia.
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8
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Kong AY, Westneat SC, Anesetti-Rothermel A, van de Venne JG, Debnam C, Ribisl KM, Cohn AM, Rose SW. Neighborhood Inequities in Tobacco Product Descriptors, Washington, DC, 2018-2019. Nicotine Tob Res 2024; 26:S73-S81. [PMID: 38817025 PMCID: PMC11140226 DOI: 10.1093/ntr/ntad226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 11/02/2023] [Accepted: 11/07/2023] [Indexed: 06/01/2024]
Abstract
BACKGROUND The tobacco industry uses product descriptors to communicate reduced harm and increase appeal. This cross-sectional study assessed store-level racial, ethnic, and socioeconomic inequities in the distribution of retail tobacco product descriptors in a convenience sample of retailers in Washington, DC. METHODS Young adults (n = 146) who did not currently use tobacco reported real-time store visits over 14 days. Trained data collectors took high-resolution photographs of all tobacco (including e-cigarette) marketing in each store (n = 96) participants visited. We coded text descriptors on tobacco product advertisements and displays into descriptor categories (eg, fruit, sweet, concept). We fit multilevel models to examine relationships between store neighborhood census tract-level racial, ethnic, and socioeconomic characteristics and tobacco product descriptors in stores. As a supplementary analysis, we used geospatial methods to model predicted patterns of descriptors at the census tract level. RESULTS Stores located in census tracts with the highest versus lowest percentage of Black residents had a greater count of fruit, sweet or dessert, alcohol, and concept descriptors (p < .05), similar to findings from the geospatial approach. Adjusted models also indicated some inequities in stores in census tracts with higher percentages of Hispanic or Latino residents for fruit, alcohol, and concept descriptors; however, tract-level models showed opposite results for concept flavors. CONCLUSIONS In this convenience sample, fruit, alcohol, sweet/dessert, and concept FTP descriptors were prevalent in stores in neighborhoods with more Black residents demonstrated through two analytic approaches. Surveillance using representative samples of tobacco retailers could improve the ability to track the extent of this inequity. IMPLICATIONS We document inequities in the amount of fruit, sweet or dessert, alcohol, and concept flavor descriptors in stores across neighborhoods in Washington, DC. Federal, state, and local regulatory action is needed to reduce inequities in flavored tobacco product availability and marketing, including for concept flavors.
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Affiliation(s)
- Amanda Y Kong
- Family & Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Susan C Westneat
- University of Kentucky, Center for Health Equity Transformation and Behavioral Science College of Medicine, Lexington, KY, USA
| | - Andrew Anesetti-Rothermel
- University of Kentucky, Center for Health Equity Transformation and Behavioral Science College of Medicine, Lexington, KY, USA
| | - Judy G van de Venne
- University of Kentucky, Center for Health Equity Transformation and Behavioral Science College of Medicine, Lexington, KY, USA
| | | | - Kurt M Ribisl
- Health Behavior, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Amy M Cohn
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Shyanika W Rose
- University of Kentucky, Center for Health Equity Transformation and Behavioral Science College of Medicine, Lexington, KY, USA
- Markey Cancer Center, Lexington, KY, USA
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Buettner-Schmidt K, Steward K, Goniewicz ML, Schaeffer Fraase K, Orr M, Miller DR. Development of a Flavor Ingredient Wheel Linking E-Liquid Additives to the Labeled Flavor of Vaping Products. TOXICS 2024; 12:372. [PMID: 38787151 PMCID: PMC11125894 DOI: 10.3390/toxics12050372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 05/11/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024]
Abstract
E-liquids contain combinations of chemicals, with many enhancing the sensory attractiveness of the product. Studies are needed to understand and characterize e-liquid ingredients, particularly flavorings, to inform future research and regulations of these products. We identified common flavor ingredients in a convenience sample of commercial e-liquids using gas chromatography-mass spectrometry. E-liquid flavors were categorized by flavor descriptors provided on the product packaging. A Flavor Ingredient Wheel was developed to link e-liquid flavor ingredients with flavor categories. An analysis of 109 samples identified 48 flavor ingredients. Consistency between the labeled flavor and ingredients used to produce such flavor was found. Our novel Flavor Ingredient Wheel organizes e-liquids by flavor and ingredients, enabling efficient analysis of the link between ingredients and their flavor profiles and allowing for quick assessment of an e-liquid ingredient's flavor profile. Investigating ingredient profiles and identifying and classifying commonly used chemicals in e-liquids may assist with future studies and improve the ability to regulate these products.
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Affiliation(s)
- Kelly Buettner-Schmidt
- School of Nursing, North Dakota State University, Fargo, ND 58108, USA; (K.S.F.); (M.O.); (D.R.M.)
| | - Katherine Steward
- Department of Chemistry and Biochemistry, Montana State University, Bozeman, MT 59717, USA;
| | - Maciej L. Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA;
| | - Kolby Schaeffer Fraase
- School of Nursing, North Dakota State University, Fargo, ND 58108, USA; (K.S.F.); (M.O.); (D.R.M.)
| | - Megan Orr
- School of Nursing, North Dakota State University, Fargo, ND 58108, USA; (K.S.F.); (M.O.); (D.R.M.)
| | - Donald R. Miller
- School of Nursing, North Dakota State University, Fargo, ND 58108, USA; (K.S.F.); (M.O.); (D.R.M.)
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Goldenson NI, Shiffman S, Sembower MA, Black RA. Assessment of abuse liability and switching potential of menthol-flavored pod-based electronic nicotine delivery systems among US adults who smoke cigarettes. Drug Alcohol Depend 2024; 258:111279. [PMID: 38614020 DOI: 10.1016/j.drugalcdep.2024.111279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/18/2024] [Accepted: 03/26/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Menthol-flavored electronic nicotine delivery systems (ENDS) are a focus of public health and regulatory policy considerations. The abuse liability of five menthol-flavored pod-based ENDS was compared to combustible cigarettes, and switching potential of ENDS was also evaluated. METHODS 215 US adults who smoke cigarettes (34.4% female; mean age[SD]=29.60[8.75]; 40.9% non-Hispanic White; mean cigarettes/day[SD]=12.04[8.52]) completed a randomized 6-arm within-person cross-over product-use study. Participants used five pod-based menthol-flavored ENDS (JUUL2 Polar Menthol 1.5%, JUUL2 Prototype Fresh Menthol 3.0%, JUUL Menthol 5.0%, Vuse Alto Menthol 5.0%, NJOY Ace Menthol 5.0%) and their usual brand (UB) cigarette for 20minutes ad libitum. After each product use, subjective reinforcing effects relevant to abuse liability and associated with switching away from cigarettes (e.g., satisfaction, product liking) were assessed. RESULTS All ENDS products were rated substantially and statistically significantly lower than UB cigarette on measures of subjective reinforcing effects (ps<0.001). Satisfying effects of JUUL2 1.5% were rated significantly higher than other ENDS products. JUUL2 Prototype 3.0% and Vuse Alto 5.0% did not significantly differ (ps>0.05), and both were rated significantly higher than JUUL 5.0% and NJOY Ace 5.0% (ps<0.05). Differences in subjective responses to study products did not significantly differ by preference for menthol cigarettes or by current ENDS use. CONCLUSIONS Abuse liability of all menthol-flavored ENDS in this study was substantially lower than combustible cigarettes. Abuse liability of JUUL2 1.5% was within the range of currently marketed pod-based menthol-flavored ENDS products. JUUL2 1.5% likely has high potential for facilitating switching among US adults who smoke.
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11
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Sommer N, Franzen K, Andreas S, Pankow W, Kunstmann W, Hanewinkel R. [Harmful health effects of flavors in e-cigarettes]. Dtsch Med Wochenschr 2024; 149:646-653. [PMID: 38458230 DOI: 10.1055/a-2260-5003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Abstract
BACKGROUND Almost all e-cigarettes contain flavorings that make the product more attractive. In the evaluation of e-cigarettes on health, flavors have so far played a subordinate role. METHOD Selective literature search in PubMed, supplemented by legal regulations on the use of flavors in e-cigarettes. RESULTS Flavors make it easier to start using e-cigarettes and have a consumption-promoting effect. Deeper inhalation increases nicotine uptake and the absorption of toxic substances from the e-cigarette liquid. For some flavors, pathological effects have been demonstrated in addition to other toxic components of the e-cigarette. To date, no toxicological analyses are available for the vast majority of flavors contained in e-cigarettes. CONCLUSIONS The proven consumption-promoting effect and the health risks that can be extrapolated from preclinical data are significant for the political discussion of a ban on flavors for e-cigarettes, analogous to the ban on flavors in tobacco products already in force.
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Affiliation(s)
- Natascha Sommer
- Medizinische Klinik II, Excellence Cluster Cardio-Pulmonary Institute (CPI), Universities of Gießen and Marburg Lung Center (UGMLC), Mitglied des Deutschen Zentrums für Lungenforschung (DZL), Justus-Liebig-Universität Gießen
| | - Klaas Franzen
- Universitätsklinikum Schleswig-Holstein, Medizinische Klinik III, Pneumologie, Campus Lübeck, Airway Research Center North (ARCN), Deutsches Zentrum für Lungenforschung (DZL), Lübeck/Großhansdorf
| | - Stefan Andreas
- Lungenfachklinik Immenhausen, Immenhausen, Klinik für Kardiologie und Pneumologie, Universitätsmedizin Göttingen, Deutsches Zentrum für Lungenforschung
| | - Wulf Pankow
- Philipps-Universität Marburg - Fachbereich Medizin
| | | | - Reiner Hanewinkel
- IFT-Nord gGmbH, Institut für Therapie- und Gesundheitsforschung, Kiel
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12
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Rupp A, Sommer N, Andreas S, Pankow W, Hanewinkel R, Wienbergen H, Batra A, Sauerbruch T, Kardos P, Ulbricht S, Brinkmann F, Scheubel R, Vogelmeier C, Windisch W. [Medical societies in Germany call for a ban on flavors in e-cigarettes - A Position Paper of the German Respiratory Society (DGP) in cooperation with other professional associations and organizations]. Pneumologie 2024; 78:320-324. [PMID: 38503310 DOI: 10.1055/a-2282-9908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
E-cigarettes are primarily used by teenagers and young adults. Flavors in e-cigarettes increase their attractiveness and encourage young people and adults to start using them. This exposes young people in particular to the risk of nicotine addiction and various toxic substances from the aerosol of e-cigarettes. There are indications that various flavors in e-cigarettes are harmful to health, although toxicological studies are still lacking for the majority of flavors. There is a need for independent scientific investigations in this area. The scientific societies involved are calling for a ban on flavors in e-cigarettes, a ban on disposable e-cigarettes, effective regulation of the sale of e-cigarettes and effective control and implementation of the provisions for the protection of minors.
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Affiliation(s)
- Alexander Rupp
- Pneumologische Praxis im Zentrum, Stuttgart, Mitglied der Arbeitsgruppe Tabakprävention und -entwöhnung der DGP, Leiter der Arbeitsgruppe Tabak im Bundesverband der Pneumologie, Schlaf- und Beatmungsmedizin, Stuttgart, Deutschland
| | - Natascha Sommer
- Medizinische Klinik II, Excellence Cluster Cardio-Pulmonary Institute (CPI), Universities of Giessen and Marburg Lung Center (UGMLC), Mitglied des Deutschen Zentrums für Lungenforschung (DZL), Justus-Liebig-Universität Gießen, Gießen, Deutschland
| | - Stefan Andreas
- Lungenfachklinik Immenhausen, Klinik für Kardiologie und Pneumologie, Universitätsmedizin Göttingen, Deutsches Zentrum für Lungenforschung, Göttingen, Deutschland
| | - Wulf Pankow
- Vivantes-Institut für Tabakentwöhnung und Raucherprävention, Berlin, Deutschland
| | - Reiner Hanewinkel
- IFT-Nord gGmbH, Institut für Therapie- und Gesundheitsforschung, Kiel, Deutschland
| | - Harm Wienbergen
- Bremer Institut für Herz- und Kreislaufforschung, Klinikum Links der Weser Bremen, Universität zu Lübeck für die Deutsche Gesellschaft für Kardiologie - Herz- und Kreislaufforschung (DGK), Bremen, Deutschland
| | - Anil Batra
- Universitätsklinik für Psychiatrie und Psychotherapie, Universität Tübingen für die Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde (DGPPN), Tübingen, Deutschland
| | - Tilman Sauerbruch
- Universität Bonn für die Deutsche Gesellschaft für Innere Medizin (DGIM), Bonn, Deutschland
| | - Peter Kardos
- Lungenzentrum Maingau, Frankfurt a. M. für die Deutsche Atemwegsliga, Frankfurt, Deutschland
| | - Sabina Ulbricht
- Abteilung für Präventionsforschung und Sozialmedizin, Universitätsmedizin Greifswald für das Aktionsbündnis Nichtrauchen, Greifswald, Deutschland
| | - Folke Brinkmann
- Sektion Kinderpneumologie und Allergologie, Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Schleswig-Holstein Campus Lübeck für die Gesellschaft für pädiatrische Pneumologie (GPP), Lübeck, Deutschland
| | - Robert Scheubel
- Klinik für Thoraxchirurgie, Fachkliniken Wangen für die Deutsche Gesellschaft für Thoraxchirurgie, Wangen, Deutschland
| | - Claus Vogelmeier
- Abteilung Pneumologie im Universitätsklinikum Gießen und Marburg, Standort Marburg für die Deutsche Lungenstiftung, Marburg, Deutschland
| | - Wolfram Windisch
- Lungenklinik, Kliniken der Stadt Köln gGmbH, Lehrstuhl für Pneumologie Universität Witten/Herdecke für die Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin, Köln, Deutschland
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13
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Assunta M, Chamberlain P. Ensuring a safe, tobacco free future for the young: protecting children from tobacco industry interference. Tob Control 2024; 33:281-282. [PMID: 38641358 DOI: 10.1136/tc-2024-058698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Affiliation(s)
- Mary Assunta
- Southeast Asia Tobacco Control Alliance, Bangkok, Thailand
- Advocacy at Global Center for Good Governance in Tobacco Control, Bangkok, Thailand
| | - Phil Chamberlain
- Tobacco Control Research Group at the University of Bath, Bath, UK
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Jabba SV, Silinski P, Yang AY, Ouyang W, Jordt SE. Artificial Sweeteners in US-Marketed Oral Nicotine Pouch Products: Correlation with Nicotine Contents and Effects on Product Preference. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.01.26.577472. [PMID: 38328200 PMCID: PMC10849646 DOI: 10.1101/2024.01.26.577472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Introduction Artificial sweeteners are listed as ingredients of oral nicotine pouches (ONPs), a new product category with rapidly growing market share. The exact sweetener contents of ONPs remain unknown. Artificial sweeteners in ONPs may facilitate initiation and encourage consumption behavior. Aims and Methods Artificial sweetener contents in major US-marketed ONP brands (Zyn, on!, Velo) were determined by Liquid Chromatography-Mass Spectrometry (LC-MS). Sweetener effects during the initiation of ONP consumption were modeled in single- and two-bottle tests, offering mice ONP extracts calibrated to contain nicotine levels similar to saliva of people who use smokeless tobacco. To examine the contribution of sweet taste perception, consumption behavior was compared between wild-type mice and mice deficient in the sweet taste receptor (Tas1r2-/-). Results Acesulfame-K was detected in on!, Zyn and Velo ONPs (~0.3-0.9 mg/pouch), including products marketed as "Unflavored" or "Flavor ban approved". In Velo ONPs, sweetened with sucralose (0.6-1.2 mg/pouch), higher nicotine strength products contained higher sucralose levels. Tas1r2-/- mice consumed less ONP extracts than wild-type mice in both sexes. ONP extracts with both higher nicotine and sweetener strengths were tolerated by wild-type mice, but produced stronger aversion in Tas1r2-/- mice. Conclusions ONPs contain significant amounts of artificial sweeteners, with some brands adding more sweetener to ONPs with higher nicotine strengths. Artificial sweeteners, at levels present in ONPs, increase nicotine consumption. Increasing sweetener contents facilitates consumption of ONPs with higher nicotine strengths. Sweetness is a key determinant of ONP use initiation, likely reducing the aversive sensory effects of nicotine and other ONP constituents. Implications Artificial sweeteners such as acesulfame-K or sucralose reduce aversion and facilitate initiation and continued consumption of ONPs. The marketing of some artificially sweetened ONPs as "Unflavored" of "Flavor ban-approved" suggests that the tobacco industry rejects sweet taste as a determinant for the presence of a characterizing flavor. Sweetness as imparted by artificial sweeteners in tobacco products needs to be addressed by regulators as a component of a characterizing flavor, with the aim to reduce product appeal and initiation by never users, and especially youth attracted to sweet flavors.
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Affiliation(s)
- Sairam V. Jabba
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA
- Yale Center for the Study of Tobacco Products (YCSTP), Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | | | - Alicia Y. Yang
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA
| | - Wenyi Ouyang
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA
| | - Sven E. Jordt
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA
- Yale Center for the Study of Tobacco Products (YCSTP), Department of Psychiatry, Yale School of Medicine, New Haven, CT
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15
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Pennings JLA, Hellmich IM, Boesveldt S, Talhout R. An ingredient co-occurrence network gives insight into e-liquid flavor complexity. Tob Induc Dis 2024; 22:TID-22-08. [PMID: 38204732 PMCID: PMC10777478 DOI: 10.18332/tid/175955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION Part of the appeal of e-cigarettes lies in their available flavors. To achieve attractive flavors, e-liquids contain many different flavoring agents, which allow many flavoring combinations. To advance our knowledge of e-liquid flavors and compositions and to evaluate the effect of legislation, we determined whether there are ingredient combinations that are frequently used together. METHODS We used e-cigarette ingredient data from the European Common Entry Gate system (EU-CEG) as available on 31 December 2022. RESULTS In e-liquids, we found 214 ingredient pairs with a co-occurrence odds ratio greater than 10. Together, these consisted of 62 unique ingredients. Network analysis revealed that ingredients were grouped together based on their flavor and/or chemical structure. We identified two densely connected regions (clusters) in the network. One consisted of six ingredients with sweet-vanilla-creamy flavors. The second cluster consisted of 13 ingredients. While some of these have fruity flavors, others, such as alkyl carboxylic acids and dimethyl sulfide, are known to have unpleasant flavors. Additional data and literature analyses indicated that alkyl carboxylic acids can contribute to a creamy and sweet-fruity taste, whereas dimethyl sulfide can contribute to a more refined fruity taste. CONCLUSIONS These results exemplify that the flavor of e-liquids is not just the sum of its parts. Big data analyses on product data can be used to detect such patterns, but expert knowledge and additional data are needed for further interpretation. Monitoring of e-liquid flavors as well as ingredients will remain important to regulate e-liquid product attractiveness.
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Affiliation(s)
- Jeroen L A Pennings
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Ina M Hellmich
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Sanne Boesveldt
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Reinskje Talhout
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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16
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Majmundar A, Xue Z, Asare S, Bandi P, Patel M, Nargis N. Concept flavor e-cigarette unit sales in the U.S.: 2019-2022. Prev Med Rep 2023; 36:102506. [PMID: 38116272 PMCID: PMC10728460 DOI: 10.1016/j.pmedr.2023.102506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 10/06/2023] [Accepted: 11/07/2023] [Indexed: 12/21/2023] Open
Abstract
Introduction Concept flavor e-cigarettes, defined as products with vague/ambiguous flavor (tobacco flavor and non-tobacco flavor) names, may limit the intended impact and enforcement of flavored tobacco restrictions. This study assessed trends in unit sales of concept flavor e-cigarettes in the U.S. by volume, nicotine concentration levels (NCL), flavor and device type. Methods We analyzed NielsenIQ Retail Scanner point-of-sales data collected from 2182 Local Trade Areas in the contiguous 48 U.S. states and the District of Columbia aggregated weekly from August 10, 2019, through April 9, 2022. Concept flavors were categorized by: flavor type (tobacco, fruity, menthol, mint, and other); device type (pods/refillable cartridges, disposables, e-liquids, and other); and NCL (0 %-2.0 %, 2.1 %-4.0 %, > 4.1 %, unknown). Joinpoint regression was used to assess sales trends. Results Overall unit sales during the study period increased by 33.63 % from 1040.85 to 1390.88 thousand units per month (p = 0.006). Between August 2019 and September 2021, unit sales increased and peaked; between September 2021 and April 2022 sales decreased by 14.46 % (from 1626.02 to 1390.88 thousand units; p = 0.002). Sales of fruity, menthol and mint flavors concept flavor e-cigarettes increased by > 1000 %; disposable devices by 302.18 %; pods and refillable cartridges by 33.81 % overall; and products NCL > 4.0 % increased by 110.18 %. Tobacco flavor concept flavors (93.28 %), pods (94.63 %), and products with 2.1 %-4.0 % NCL (88.40 %) dominated unit share. Conclusion Sustaining the recent overall decline in the unit sales of concept flavor e-cigarettes and monitoring the sales of products with nicotine concentration greater than 2.0%, non-tobacco flavor, and pod products warrant prioritization in tobacco control efforts.
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Affiliation(s)
- Anuja Majmundar
- Tobacco Control Research, American Cancer Society, Inc., 270 Peachtree StreetAtlanta, GA 30303, USA
| | - Zheng Xue
- Tobacco Control Research, American Cancer Society, Inc., 270 Peachtree StreetAtlanta, GA 30303, USA
| | - Samuel Asare
- Tobacco Control Research, American Cancer Society, Inc., 270 Peachtree StreetAtlanta, GA 30303, USA
| | - Priti Bandi
- Risk Factors and Screening Surveillance Research, American Cancer Society, Inc., 270 Peachtree StreetAtlanta, GA 30303, USA
| | - Minal Patel
- Tobacco Control Research, American Cancer Society, Inc., 270 Peachtree StreetAtlanta, GA 30303, USA
| | - Nigar Nargis
- Tobacco Control Research, American Cancer Society, Inc., 270 Peachtree StreetAtlanta, GA 30303, USA
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Tackett AP, Han DH, Peraza N, Whaley RC, Mason T, Cahn R, Hong K, Pang R, Monterosso J, Page MK, Goniewicz ML, Leventhal AM. Effects of 'Ice' flavoured e-cigarettes with synthetic cooling agent WS-23 or menthol on user-reported appeal and sensory attributes. Tob Control 2023:tc-2023-058125. [PMID: 37940405 DOI: 10.1136/tc-2023-058125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 10/24/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND This clinical experiment tested the effects of exposure to e-cigarettes with WS-23 or menthol cooling additives on user appeal and sensory attributes, and, secondarily, whether WS-23 effects generalised across base characterising flavour, nicotine concentration, or nicotine/tobacco product use status. METHODS In this within-participant double-blind experiment, adult tobacco/nicotine users administered standardised puffs of 18 different e-cigarette solutions in randomised sequences using a pod-style device. Each of three base characterising e-cigarette flavour solutions ('bold tobacco', 'mango,' 'wintergreen') in both 2% and 4% concentrations of nicotine benzoate salt were manipulated by adding either: (1) Menthol (0.5%), (2) WS-23 (0.75%) or (3) No cooling agent. After each administration, participants rated 3 appeal and 5 sensory attributes (0-100 scales). RESULTS Participants (n=84; M(SD)=38.6 (13.6) years old) were either exclusive e-cigarette (25.0%), cigarette (36.9%) or dual (38.1%) users. WS-23 versus no coolant products produced higher liking, willingness to use again, smoothness, and coolness and lower disliking, bitterness, and harshness ratings (|B|difference range: 4.8 to 20.1; ps<0.005). Menthol (vs no coolant) increased willingness to use again and reduced harshness and coolness (ps<0.05). Flavours with WS-23 (vs menthol) were rated as smoother, cooler and less harsh (ps<0.05). Coolant effects did not differ by base flavour, nicotine concentration, or tobacco use status. CONCLUSIONS Adding synthetic coolant WS-23 to e-cigarettes appears to make the vaping user experience more appealing, regardless of characterising base flavour. Regulatory agencies should be aware that the manufacturing process of adding synthetic coolants may increase the attractiveness of various e-cigarette products.Cite Now.
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Affiliation(s)
- Alayna P Tackett
- Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Dae Hee Han
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
- Institute for Addiction Science, Univeresity of Southern California, Los Angeles, CA, USA
| | - Natalia Peraza
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Reid C Whaley
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Tyler Mason
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, California, USA
| | - Rael Cahn
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, California, USA
| | - Kurt Hong
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, California, USA
- Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Raina Pang
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - John Monterosso
- Institute for Addiction Science, Univeresity of Southern California, Los Angeles, CA, USA
- Department of Psychology, University of Southern California, Los Angeles, California, USA
| | - Michelle K Page
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Maciej Lukasz Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Adam M Leventhal
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
- Institute for Addiction Science, Univeresity of Southern California, Los Angeles, CA, USA
- Department of Psychology, University of Southern California, Los Angeles, California, USA
- USC Norris Comprehensive Cancer Center, Los Angeles, CA, USA
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Wong M, Martinez T, Tran M, Zuvia C, Gadkari A, Omaiye EE, Luo W, McWhirter KJ, Sha J, Kassem A, Wohlschlegel J, Talbot P. A synthetic coolant (WS-23) in disposable electronic cigarettes impairs cytoskeletal function in EpiAirway microtissues exposed at the air liquid interface. Sci Rep 2023; 13:16906. [PMID: 37805554 PMCID: PMC10560211 DOI: 10.1038/s41598-023-43948-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 09/30/2023] [Indexed: 10/09/2023] Open
Abstract
The design of popular disposable electronic cigarettes (ECs) was analyzed, and the concentrations of WS-23, a synthetic coolant, in EC fluids were determined for 22 devices from 4 different brands. All products contained WS-23 in concentrations that ranged from 1.0 to 40.1 mg/mL (mean = 21.4 ± 9.2 mg/mL). To determine the effects of WS-23 on human bronchial epithelium in isolation of other chemicals, we exposed EpiAirway 3-D microtissues to WS-23 at the air liquid interface (ALI) using a cloud chamber that generated aerosols without heating. Proteomics analysis of exposed tissues revealed that the cytoskeleton was a major target of WS-23. BEAS-2B cells were exposed to WS-23 in submerged culture to validate the main results from proteomics. F-actin, which was visualized with phalloidin, decreased concentration dependently in WS-23 treated BEAS-2B cells, and cells became immotile in concentrations above 1.5 mg/mL. Gap closure, which depends on both cell proliferation and migration, was inhibited by 0.45 mg/mL of WS-23. These data show that WS-23 is being added to popular EC fluids at concentrations that can impair processes dependent on the actin cytoskeleton and disturb homeostasis of the bronchial epithelium. The unregulated use of WS-23 in EC products may harm human health.
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Affiliation(s)
- Man Wong
- Department of Molecular, Cell and Systems Biology, University of California, Riverside, CA, 92521, USA
| | - Teresa Martinez
- Department of Molecular, Cell and Systems Biology, University of California, Riverside, CA, 92521, USA
| | - Mona Tran
- Department of Molecular, Cell and Systems Biology, University of California, Riverside, CA, 92521, USA
| | - Cori Zuvia
- Department of Molecular, Cell and Systems Biology, University of California, Riverside, CA, 92521, USA
| | - Alisa Gadkari
- Department of Molecular, Cell and Systems Biology, University of California, Riverside, CA, 92521, USA
| | - Esther E Omaiye
- Department of Molecular, Cell and Systems Biology, University of California, Riverside, CA, 92521, USA
| | - Wentai Luo
- Department of Civil and Environmental Engineering, Portland State University, Portland, OR, 97207, USA
| | - Kevin J McWhirter
- Department of Civil and Environmental Engineering, Portland State University, Portland, OR, 97207, USA
| | - Jihui Sha
- Department of Biological Chemistry, David Geffen School of Medicine at University of California, Los Angeles, CA, 90095, USA
| | - Ahmad Kassem
- Department of Biological Chemistry, David Geffen School of Medicine at University of California, Los Angeles, CA, 90095, USA
| | - James Wohlschlegel
- Department of Biological Chemistry, David Geffen School of Medicine at University of California, Los Angeles, CA, 90095, USA
| | - Prue Talbot
- Department of Molecular, Cell and Systems Biology, University of California, Riverside, CA, 92521, USA.
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Donaldson CD, Couch ET, Hoeft KS, Wilkinson ML, Guerra C, Gansky SA, Zhang X, Chaffee BW. Flavored Tobacco and Nicotine Use Among California Adolescents: Preferences by Use Experience and Survey Format Effects. J Adolesc Health 2023; 73:753-760. [PMID: 37389531 PMCID: PMC10528341 DOI: 10.1016/j.jadohealth.2023.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 05/08/2023] [Accepted: 05/10/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE This study assessed flavored tobacco use among adolescent e-cigarette, cigarette, cigar, hookah, and smokeless tobacco users; specific e-cigarette flavor preferences; risk profiles of youth that use various flavors; and the impact of survey question wording on prevalence. METHODS Cross-sectional data from 4,956 California adolescent participants (aged 12-17 years) in the Teens, Nicotine, and Tobacco 2021-2022 online panel survey estimated the survey-weighted prevalence of flavored tobacco use. An embedded randomized experiment assessed survey wording effects (i.e., any vs. "usual" flavor use). Qualitative data from four contemporaneous cycles of Teens, Nicotine, and Tobacco focus groups with California adolescents (N = 63) added themes relevant to the quantitative findings. RESULTS 88.1% of current any tobacco users reported flavored tobacco use in the past 30 days. Flavor use was lowest for cigarettes (66.7%) and highest for hookah (92.8%). Fruit was the most popular e-cigarette flavor (51.6% any use; 28.8% usual use). E-cigarette users also commonly reported use of candy and cooling flavors. Sweet flavors were used most often among adolescents otherwise at low risk of tobacco use. Survey item format did not meaningfully affect overall prevalence of flavored product use but did impact reports of specific e-cigarette flavors. Focus group participants described sweet and fruity flavors as a motivating factor in their own e-cigarette use and as designed to appeal to children. DISCUSSION Despite local policies, flavored tobacco use remains common among California adolescents. Survey items asking about any flavor use rather than usual use provide more information without affecting the overall prevalence of flavored tobacco use.
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Affiliation(s)
- Candice D Donaldson
- California Tobacco Control Program, California Department of Public Health, Sacramento, California
| | - Elizabeth T Couch
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California
| | - Kristin S Hoeft
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California
| | - Monica L Wilkinson
- California Tobacco Control Program, California Department of Public Health, Sacramento, California
| | - Claudia Guerra
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California
| | - Stuart A Gansky
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California
| | - Xueying Zhang
- California Tobacco Control Program, California Department of Public Health, Sacramento, California
| | - Benjamin W Chaffee
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California.
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20
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Liu AH, Hootman J, Li D, Xie Z. Public perceptions of synthetic cooling agents in electronic cigarettes on Twitter. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.21.23295881. [PMID: 37808831 PMCID: PMC10557767 DOI: 10.1101/2023.09.21.23295881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Amid a potential menthol ban, electronic cigarette (e-cigarette) companies are incorporating synthetic cooling agents like WS-3 and WS-23 to replicate menthol/mint sensations. This study examines public views on synthetic cooling agents in e-cigarettes via Twitter data. From May 2021 to March 2023, we used Twitter Streaming API, to collect tweets related to synthetic cooling agents with keywords such as 'WS-23,' 'ice,' and 'frozen.' Two deep learning roBERTa models, classified attitudes expressed in tweets about synthetic cooling agents and identified e-cigarette users. The BERTopic deep-learning model identified major topics of positive and negative tweets. Two proportion Z-tests were used to compare the proportions of positive and negative attitudes between e-cigarette users (vapers) and non-e-cigarette-users (non-vapers). Of 6,940,065 e-cigarettes related tweets, 5,788 non-commercial tweets related to synthetic cooling agents. The longitudinal trend analysis showed a clear upwards trend in discussions. Vapers posted most of the tweets (73.05%, 4,228/5,788). Nearly half (47.87%, 2,771/5,788) held a positive attitude toward synthetic cooling agents, which is significantly higher than those with a negative attitude (19.92%,1,153/5,788) with a P-value < 0.0001. The likelihood of Vapers expressing positive attitudes (60.17%, 2,544/4,228) was significantly higher (P < 0.0001) than that from non-vapers (14.55%, 227/1,560). Conversely, negative attitudes from non-vapers (30%, 468/1,560) was significantly (P < 0.0001) higher than vapers (16.2%, 685/4,228). Prevalent topics from positive tweets included "enjoyment of specific vape flavors," "preference for lush ice vapes," and "liking of minty/icy feelings." Major topics from negative tweets included "disliking certain vape flavors" and "dislike of others vaping around them." On Twitter, vapers are more likely to have a positive attitude toward synthetic cooling agents than non-vapers. Our study provides important insights into how the public perceives synthetic cooling agents in e-cigarettes, insights that are crucial for shaping future FDA regulations aimed at safeguarding public health.
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Affiliation(s)
- Andrew H. Liu
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Julia Hootman
- Department of Computer Science, Xavier University, Cincinnati, Ohio
| | - Dongmei Li
- Department of Clinical and Translational Research, University of Rochester Medical Center, Rochester, New York
| | - Zidian Xie
- Department of Clinical and Translational Research, University of Rochester Medical Center, Rochester, New York
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Klupinski TP, Strozier ED, Koebel DD, Lucas EA. Detection of the Synthetic Coolant Menthone 1,2-Glycerol Ketal in an e-Liquid and in Electronic Waterpipe Aerosols Therefrom. Chem Res Toxicol 2023; 36:1355-1360. [PMID: 37439580 PMCID: PMC10529952 DOI: 10.1021/acs.chemrestox.3c00089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
The presence and toxicological risks of synthetic coolants in electronic nicotine delivery systems (ENDS) have not been thoroughly studied. We identified the synthetic coolant menthone 1,2-glycerol ketal (MGK) in a menthol-flavored e-liquid at a concentration of ∼170 μg/mL. We also detected MGK in aerosols resulting from heating the e-liquid with an electronic waterpipe. MGK was initially detected in the e-liquid by two-dimensional gas chromatography-time-of-flight mass spectrometry. To avoid potential analytical artifacts that could result from heating samples in the injection port of the gas chromatograph, quantitation of MGK in the e-liquid was accomplished using a liquid chromatography-tandem mass spectrometry method. Following recent reports identifying other synthetic coolants in e-liquids, these results add knowledge about inhalation exposures from ENDS use and suggest the importance of future research to study the potential inhalation toxicity related to the use of MGK-containing e-liquids in ENDS devices. Furthermore, the results demonstrate the ability to quantify ketals in e-liquids using liquid chromatography methods.
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Affiliation(s)
| | | | - David D Koebel
- Battelle, 505 King Ave., Columbus, Ohio 43201, United States
| | - Eric A Lucas
- Battelle, 505 King Ave., Columbus, Ohio 43201, United States
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Page MK, Paul EE, Leigh NJ, Meza LR, Galimov A, Sussman S, Leventhal A, O'Connor RJ, Goniewicz ML. Still 'Cool': tobacco industry responds to state-wide menthol ban with synthetic coolants. Tob Control 2023:tc-2023-058149. [PMID: 37500508 DOI: 10.1136/tc-2023-058149] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023]
Abstract
INTRODUCTION In December 2022, California (CA) enforced a voter-approved regulation restricting the retail sale of flavoured tobacco products, including menthol cigarettes. Shortly after, new products emerged on the market containing similar blue and green package colours yet with 'non-menthol' descriptors. Using chemical analyses, we measured the content of menthol and 15 other cooling chemicals in Californian cigarettes with 'non-menthol' descriptors and compared concentrations to similar 'menthol'-labelled counterparts available in New York State (NY). METHODS A convenience sample of 10 brands and types of cigarettes in CA were purchased based on package colours suggesting a cooling effect and/or 'non-menthol' descriptors. The exact brand and type of cigarettes (with menthol descriptors) were purchased in NY. Cigarettes from CA were compared with equivalent cigarettes from NY on package design and colours, cigarette physical characteristics and the presence of cooling additives. RESULTS Menthol was not detected in any CA cigarette, except for Maverick-green box type, while its presence was confirmed in most NY counterpart products. A synthetic cooling chemical WS-3 was not detected in any NY cigarettes but was detected in four CA brands and types with implied cooling effect, ranging from 1.24±0.04 to 1.97±0.05 mg/cigarette. CONCLUSION While manufacturers have removed menthol descriptors from CA packaging and the menthol ingredient from cigarettes, synthetic cooling chemicals detected in several CA brands suggest that cooling sensory effects may still be sustained. Policymakers must consider both the chemical ingredients themselves and sensory effects in future regulatory approaches.
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Affiliation(s)
- Michelle K Page
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Emily E Paul
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Noel J Leigh
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Leah R Meza
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Artur Galimov
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Steve Sussman
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Departments of Preventive Medicine and Psychology, and School of Social Work, University of Southern California, Pasadena, California, USA
- Institute for Addiction Science, University of Southern California, Los Angeles, California, USA
| | - Adam Leventhal
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Institute for Addiction Science, University of Southern California, Los Angeles, California, USA
| | - Richard J O'Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Maciej L Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
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Meza LR, Galimov A, Sussman S, Goniewicz ML, Page MK, Leventhal A. Proliferation of 'non-menthol' cigarettes amid a state-wide flavour ban. Tob Control 2023:tc-2023-058074. [PMID: 37474314 DOI: 10.1136/tc-2023-058074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/05/2023] [Indexed: 07/22/2023]
Affiliation(s)
- Leah R Meza
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Artur Galimov
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Steve Sussman
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
- Department of Psychology, and School of Social Work, University of Southern California, Los Angeles, California, USA
- Institute for Addiction Science, University of Southern California, Los Angeles, California, USA
| | - Maciej Lukasz Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Michelle K Page
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Adam Leventhal
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
- Institute for Addiction Science, University of Southern California, Los Angeles, California, USA
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Jabba SV, Erythropel HC, Woodrow JG, Anastas PT, O'Malley S, Krishnan-Sarin S, Zimmerman JB, Jordt SE. Synthetic cooling agent in oral nicotine pouch products marketed as 'Flavour-Ban Approved'. Tob Control 2023:tc-2023-058035. [PMID: 37380351 PMCID: PMC10753027 DOI: 10.1136/tc-2023-058035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 06/09/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND US sales of oral nicotine pouches (ONPs) have rapidly increased, with cool/mint-flavoured ONPs the most popular flavour category. Restrictions on sales of flavoured tobacco products have either been implemented or proposed by several US states and localities. Zyn, the most popular ONP brand, is marketing Zyn Chill and Zyn Smooth as 'Flavour-Ban Approved' or 'unflavoured', probably to evade flavour bans and increase product appeal. At present, it is unclear whether these ONPs are indeed free of flavour additives that can impart pleasant sensations such as cooling. METHODS Sensory cooling and irritant activities of 'Flavour-Ban Approved' Zyn ONPs, Chill and Smooth, along with minty varieties (Cool Mint, Peppermint, Spearmint, Menthol), were analysed by Ca2+ microfluorimetry in HEK293 cells expressing the cold/menthol (TRPM8) or menthol/irritant receptor (TRPA1). Flavour chemical content of these ONPs was analysed by gas chromatography/mass spectrometry. RESULTS Zyn Chill ONP extracts robustly activated TRPM8, with much higher efficacy (39%-53%) than the mint-flavoured ONPs. In contrast, mint-flavoured ONP extracts elicited stronger TRPA1 irritant receptor responses than Chill extracts. Chemical analysis demonstrated that Chill exclusively contained WS-3, an odourless synthetic cooling agent, while mint-flavoured ONPs contained WS-3 together with mint flavourants. CONCLUSIONS ONP products marketed as 'Flavour-Ban Approved' or 'unflavoured' contain flavouring agents, proving that the manufacturer's advertising is misleading. Synthetic coolants such as WS-3 can provide a robust cooling sensation with reduced sensory irritancy, thereby increasing product appeal and use. Regulators need to develop effective strategies for the control of odourless sensory additives used by the industry to bypass flavour bans.
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Affiliation(s)
- Sairam V Jabba
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
- Yale Tobacco Center of Regulatory Science, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Hanno C Erythropel
- Yale Tobacco Center of Regulatory Science, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
- Chemical and Environmental Engineering, Yale University, New Haven, Connecticut, USA
| | | | - Paul T Anastas
- Center for Green Chemistry & Green Engineering, Yale University, New Haven, Connecticut, USA
- Department of Forestry and Environmental Studies, Yale University, New Haven, Connecticut, USA
| | - Stephanie O'Malley
- Yale Tobacco Center of Regulatory Science, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
- Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Suchitra Krishnan-Sarin
- Yale Tobacco Center of Regulatory Science, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
- Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Julie B Zimmerman
- Yale Tobacco Center of Regulatory Science, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
- Chemical and Environmental Engineering, Yale University, New Haven, Connecticut, USA
| | - Sven Eric Jordt
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
- Yale Tobacco Center of Regulatory Science, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
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Shusterman D. Trigeminal Function in Sino-Nasal Health and Disease. Biomedicines 2023; 11:1778. [PMID: 37509418 PMCID: PMC10376906 DOI: 10.3390/biomedicines11071778] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/17/2023] [Accepted: 06/19/2023] [Indexed: 07/30/2023] Open
Abstract
The upper airway (nasal passages, paranasal sinuses, pharynx, and glottis) provides the sentinel portion of the human respiratory tract, with the combined senses of olfaction (cranial nerve I) and trigeminal sensation (cranial nerve V) signaling the quality of inspired air. Trigeminal function also complements the sense of taste (in turn mediated by cranial nerves VII, IX and X), and participates in the genesis of taste aversions. The ability of trigeminal stimulation in the upper aero-digestive tract to trigger a variety of respiratory and behavioral reflexes has long been recognized. In this context, the last three decades has seen a proliferation of observations at a molecular level regarding the mechanisms of olfaction, irritation, and gustation. Concurrently, an ever-widening network of physiological interactions between olfaction, taste, and trigeminal function has been uncovered. The objective of this review is to summarize the relatively recent expansion of research in this sub-field of sensory science, and to explore the clinical and therapeutic implications thereof.
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Affiliation(s)
- Dennis Shusterman
- Division of Occupational, Environmental and Climate Medicine, University of California, San Francisco, CA 94143-0843, USA
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26
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Tackett AP, Dai HD, Han DH, Vogel EA, Coreas SI, Jafarzadeh N, Gonzalez Anaya MJ, Patel D, Peraza N, Mason TB, Leventhal AM. Appeal of e-cigarette flavors: Differences between never and ever use of combustible cigarettes. Drug Alcohol Depend 2023; 246:109849. [PMID: 37028103 PMCID: PMC10161874 DOI: 10.1016/j.drugalcdep.2023.109849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 02/28/2023] [Accepted: 03/08/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Characterizing the appeal of flavored e-cigarette solutions by tobacco product use status can inform regulations to reduce vaping in those who never smoked without discouraging adopting e-cigarettes as a quit-smoking aid. METHODS Adults aged 21+ who currently use tobacco products (N = 119) self-administered standardized puffs of eight non-tobacco flavored and two tobacco-flavored e-cigarette solutions using a pod-style device. Participants rated appeal (0-100 scale) following each administration. Mean differences in flavor appeal ratings were compared between four groups: people who never smoked/currently vape, formerly smoked/currently vape, currently smoke/currently vape, and currently smoke/do not vape (with interest in vaping). RESULTS The Global Flavor (all non-tobacco vs. tobacco)×Group interaction (p = .028) revealed higher appeal for non-tobacco vs. tobacco flavors in adults who never smoked/currently vape (B[95 %CI] = 13.6[4.1-23.1]), formerly smoked/currently vape (B[95 %CI] = 11.6[4.2-18.9]), and currently smoke/currently vape (B[95 %CI] = 9.3[2.5-11.6]), but not adults who currently smoke/never vaped (B[95 %CI] = -0.1[-5.1 to 4.9]). In flavor-specific analyses, adults who never smoked/currently vape rated strawberry (p = .022), peppermint (p = .028), and menthol (p = .028) more appealing than tobacco flavors. Among adults who formerly smoked/currently vape, strawberry (p < .001), peppermint (p = .009), and vanilla (p = .009), were more appealing than tobacco. Adults who currently smoked/currently vape rated peppermint (p = .022) and vanilla (p = .009) as more appealing than tobacco. No non-tobacco flavors were more appealing than tobacco in adults who currently smoke/never vaped. CONCLUSIONS E-cigarette sales restrictions on non-tobacco flavors, including menthol, may eliminate products preferred by adults who vape, including those who never smoked, without discouraging adults who currently smoke and never vaped from trying e-cigarettes.
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Affiliation(s)
- Alayna P Tackett
- Department of Internal Medicine, The Ohio State University, Columbus, OH, United States; Center for Tobacco Research, The Ohio State University, Columbus, OH, United States
| | - Hongying Daisy Dai
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, United States
| | - Dae-Hee Han
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, CA, United States; Institute for Addiction Science, University of Southern California, Los Angeles, CA, United States
| | - Erin A Vogel
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Saida I Coreas
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, CA, United States
| | - Nikki Jafarzadeh
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, CA, United States; Institute for Addiction Science, University of Southern California, Los Angeles, CA, United States
| | - Maria J Gonzalez Anaya
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, CA, United States
| | - Devaki Patel
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, CA, United States; Institute for Addiction Science, University of Southern California, Los Angeles, CA, United States
| | - Natalia Peraza
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, CA, United States; Institute for Addiction Science, University of Southern California, Los Angeles, CA, United States
| | - Tyler B Mason
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, CA, United States; Institute for Addiction Science, University of Southern California, Los Angeles, CA, United States
| | - Adam M Leventhal
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, CA, United States; Institute for Addiction Science, University of Southern California, Los Angeles, CA, United States; Department of Psychology, University of Southern California, Los Angeles, CA, United States.
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Pokhrel P, Kawamoto CT, Mettias H, Elwir T, Herzog T. Predictors of Discontinued E-Cigarette Use at One-Year Follow-Up in a Sample of Young Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4770. [PMID: 36981678 PMCID: PMC10049494 DOI: 10.3390/ijerph20064770] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/04/2023] [Accepted: 03/06/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Currently, the research on factors associated with young adults' discontinuation of e-cigarette use behavior is limited. This study tested the predictors of self-reported e-cigarette abstinence at one-year follow-up among young adult baseline current e-cigarette users. The following variables were tested as predictors: demographics, cigarette smoking, e-cigarette use dependence, e-cigarette use duration, harm perceptions, and preferred aspects of e-cigarette use, including sensations, flavor, and device characteristics. METHODS Data were provided at two time-points one year apart by 435 ethnically diverse young adults (M age = 22.3, SD = 3.1; 63% women) who reported current e-cigarette use at baseline. RESULTS Approximately 42% of those who reported current e-cigarette use at baseline (i.e., 184 out of 435 participants) reported discontinuation of e-cigarette use at one-year follow-up. Results indicated that higher e-cigarette dependence, longer history of e-cigarette use, lower e-cigarette harm perceptions, greater preference for both menthol and sweet flavors, for open-pod-based devices, and for e-cigarette use sensations such as buzz, taste and smell of flavors, and throat hit at baseline were associated with lower likelihood of e-cigarette use discontinuation at one-year follow-up. CONCLUSIONS Characteristics associated with nicotine (e.g., dependence) and flavors (e.g., taste and smell) appear to drive the continuation/discontinuation of e-cigarette use among young adults. Thus, cessation strategies may need to be developed with a focus on dependence and harm perceptions related to nicotine and flavors. Furthermore, better regulating open-pod-based devices and sweet-menthol flavors may help e-cigarette use prevention.
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Synthetic Cooling Agent in Oral Nicotine Pouch Products Marketed as "Flavor-Ban Approved". BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.02.23.529797. [PMID: 36865160 PMCID: PMC9980044 DOI: 10.1101/2023.02.23.529797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Background US sales of oral nicotine pouches (ONPs) have rapidly increased, with cool/mint-flavored ONPs the most popular. Restrictions on sales of flavored tobacco products have either been implemented or proposed by several US states and localities. Zyn, the most popular ONP brand, is marketing Zyn-"Chill" and Zyn-"Smooth" as "Flavor-Ban Approved", probably to evade flavor bans. At present it is unclear whether these ONPs are indeed free of flavor additives that can impart pleasant sensations such as cooling. Methods Sensory cooling and irritant activities of "Flavor-Ban Approved" ONPs, Zyn-"Chill" and "Smooth", along with "minty" varieties (Cool Mint, Peppermint, Spearmint, Menthol), were analyzed by Ca2+ microfluorimetry in HEK293 cells expressing the cold/menthol (TRPM8) or menthol/irritant receptor (TRPA1). Flavor chemical content of these ONPs was analyzed by GC/MS. Results Zyn-"Chill" ONP extracts robustly activated TRPM8, with much higher efficacy (39-53%) than the mint-flavored ONPs. In contrast, mint-flavored ONP extracts elicited stronger TRPA1 irritant receptor responses than Zyn-"Chill" extracts. Chemical analysis demonstrated the presence of WS-3, an odorless synthetic cooling agent, in Zyn-"Chill" and several other mint-flavored Zyn-ONPs. Conclusions Synthetic cooling agents such as WS-3 found in 'Flavor-Ban Approved' Zyn-"Chill" can provide a robust cooling sensation with reduced sensory irritancy, thereby increasing product appeal and use. The label "Flavor-Ban Approved" is misleading and may implicate health benefits. Regulators need to develop effective strategies for the control of odorless sensory additives used by the industry to bypass flavor bans.
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Brown JL, Neptune E. Role of Menthol and Other Flavors on Tobacco and Nicotine Product Use. Respir Med 2023. [DOI: 10.1007/978-3-031-24914-3_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Alhadyan SK, Sivaraman V, Onyenwoke RU. E-cigarette Flavors, Sensory Perception, and Evoked Responses. Chem Res Toxicol 2022; 35:2194-2209. [PMID: 36480683 DOI: 10.1021/acs.chemrestox.2c00268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The chemosensory experiences evoked by flavors encompass a number of unique sensations that include olfactory stimuli (smell), gustatory stimuli (taste, i.e., salty, sweet, sour, bitter, and umami (also known as "savoriness")), and chemesthesis (touch). As such, the responses evoked by flavors are complex and, as briefly stated above, involve multiple perceptive mechanisms. The practice of adding flavorings to tobacco products dates back to the 17th century but is likely much older. More recently, the electronic cigarette or "e-cigarette" and its accompanying flavored e-liquids emerged on to the global market. These new products contain no combustible tobacco but often contain large concentrations (reported from 0 to more than 50 mg/mL) of nicotine as well as numerous flavorings and/or flavor chemicals. At present, there are more than 400 e-cigarette brands available along with potentially >15,000 different/unique flavored products. However, surprisingly little is known about the flavors/flavor chemicals added to these products, which can account for >1% by weight of some e-liquids, and their resultant chemosensory experiences, and the US FDA has done relatively little, until recently, to regulate these products. This article will discuss e-cigarette flavors and flavor chemicals, their elicited responses, and their sensory effects in some detail.
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Affiliation(s)
- Shatha K Alhadyan
- Department of Pharmaceutical Sciences, North Carolina Central University, Durham, North Carolina 27707, United States
| | - Vijay Sivaraman
- Department of Biological and Biomedical Sciences, North Carolina Central University, Durham, North Carolina 27707, United States
| | - Rob U Onyenwoke
- Department of Pharmaceutical Sciences, North Carolina Central University, Durham, North Carolina 27707, United States.,Biomanufacturing Research Institute and Technology Enterprise (BRITE), North Carolina Central University, Durham, North Carolina 27707, United States
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Non-Targeted Chemical Characterization of JUUL-Menthol-Flavored Aerosols Using Liquid and Gas Chromatography. SEPARATIONS 2022. [DOI: 10.3390/separations9110367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aerosol constituents generated from JUUL Menthol pods with 3.0% and 5.0% nicotine by weight (Me3 and Me5) are characterized by a non-targeted approach, which was developed to detect aerosol constituents that are not known to be present beforehand or that may be measured with targeted methods. Three replicates from three production batches (n = 9) were aerosolized using two puffing regimens (intense and non-intense). Each of the 18 samples were analyzed by gas chromatography electron ionization mass spectrometry and by liquid chromatography electrospray ionization high-resolving power mass spectrometry. All chemical constituents determined to differ from control were identified and semi-quantified. To have a complete understanding of the aerosol constituents and chemistry, each chemical constituent was categorized into one of five groups: (1) flavorants, (2) harmful and potentially harmful constituents, (3) leachables, (4) reaction products, and (5) chemical constituents that were unable to be identified or rationalized (e.g., chemical constituents that could not be categorized in groups (1–4). Under intense puffing, 74 chemical constituents were identified in Me3 aerosols and 68 under non-intense puffing, with 53 chemical constituents common between both regimens. Eighty-three chemical constituents were identified in Me5 aerosol using an intense puffing regimen and seventy-five with a non-intense puffing regimen, with sixty-two chemical constituents in common. Excluding primary constituents, reaction products accounted for the greatest number of chemical constituents (approximately 60% in all cases, ranging from about 0.05% to 0.1% by mass), and flavorants—excluding menthol—comprised the second largest number of chemical constituents (approximately 25%, ranging consistently around 0.01% by mass). The chemical constituents detected in JUUL aerosols were then compared to known constituents from cigarette smoke to determine the relative chemical complexities and commonalities/differences between the two. This revealed (1) a substantial decrease in the chemical complexity of JUUL aerosols vs. cigarette smoke and (2) that there are between 55 (Me3) and 61 (Me5) unique chemical constituents in JUUL aerosols not reported in cigarette smoke. Understanding the chemical complexity of JUUL aerosols is important because the health effects of combustible cigarette smoke are related to the combined effect of these chemical constituents through multiple mechanisms, not just the effects of any single smoke constituent.
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Ma S, Qiu Z, Yang Q, Bridges JFP, Chen J, Shang C. Expanding the E-Liquid Flavor Wheel: Classification of Emerging E-Liquid Flavors in Online Vape Shops. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192113953. [PMID: 36360834 PMCID: PMC9658901 DOI: 10.3390/ijerph192113953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/19/2022] [Accepted: 10/25/2022] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Electronic cigarettes are the most popular tobacco product among U.S. youth, and over 80% of current youth users of e-cigarettes use flavored e-cigarettes, with fruit, mint/menthol, and candy/sweets being the most popular flavors. A number of new e-liquid flavors are currently emerging in the online e-cigarette market. Menthol and other flavored e-cigarettes could incentivize combustible tobacco smokers to transition to e-cigarette use. METHODS From February to May 2021, we scraped data of over 14,000 e-liquid products, including detailed descriptions of their flavors, from five national online vape shops. Building upon the existing e-liquid flavor wheel, we expanded the semantic databases (i.e., key terms) to identify flavors using WordNet-a major database for keyword matching and group discussion. Using the enriched databases, we classified 14,000+ e-liquid products into the following 11 main flavor categories: "fruit", "dessert/candy/sweets", "coffee/tea", "alcohol", "other beverages", "tobacco", "mint/menthol", "nuts", "spices/pepper", "other flavors", and "unspecified flavor". RESULTS We find that the most prominent flavor sold in the five online vape shop in 2021 was fruit flavored products, followed by dessert/candy/other sweets. Online vendors often label a product with several flavor profiles, such as fruit and menthol. CONCLUSIONS Given that online stores market products with multiple flavor profiles and most of their products contain fruit flavor, the FDA may have issued marketing denial orders to some of these products. It is important to further examine how online stores respond to the FDA flavor restrictions (e.g., compliance or non-compliance).
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Affiliation(s)
- Shaoying Ma
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH 43214, USA
| | - Zefeng Qiu
- Department of Computer Science and Engineering, The Ohio State University, Columbus, OH 43210, USA
| | - Qian Yang
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH 43214, USA
| | - John F. P. Bridges
- Department of Biomedical Informatics, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Jian Chen
- Department of Computer Science and Engineering, The Ohio State University, Columbus, OH 43210, USA
| | - Ce Shang
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
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Pipe AL, Mir H. E-Cigarettes Reexamined: Product Toxicity. Can J Cardiol 2022; 38:1395-1405. [PMID: 36089290 DOI: 10.1016/j.cjca.2022.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 08/03/2022] [Accepted: 08/03/2022] [Indexed: 12/24/2022] Open
Abstract
The introduction of e-cigarettes, or electronic nicotine delivery systems (ENDS), has been accompanied by controversy regarding their safety and effectiveness as a cessation aid and by an explosion in their use by youth. Their use does not involve the combustion of tobacco and the creation of harmful combustion products; they have been seen as a "harm reduction" tool that may be of assistance in promoting smoking cessation. Recognition that ENDS can deliver an array of chemicals and materials with known adverse consequences has spurred more careful examination of these products. Nicotine, nitrosamines, carbonyl compounds, heavy metals, free radicals, reactive oxygen species, particulate matter, and "emerging chemicals of concern" are among the constituents of the heated chemical aerosol that is inhaled when ENDS are used. They raise concerns for cardiovascular and respiratory health that merit the attention of clinicians and regulatory agencies. Frequently cited concerns include evidence of disordered respiratory function, altered hemodynamics, endothelial dysfunction, vascular reactivity, and enhanced thrombogenesis. The absence of evidence of the consequences of their long-term use is of additional concern. Their effectiveness as cessation aids and beneficial impact on health outcomes continue to be examined. It is important to ensure that their production and availability are thoughtfully regulated to optimise their safety and permit their use as harm reduction devices and potentially as smoking-cessation aids. It is equally vital to effectively prevent them from becoming ubiquitous consumer products with the potential to rapidly induce nicotine addiction among large numbers of youth. Clinicians should understand the nature of these products and the implications of their use.
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Affiliation(s)
- Andrew L Pipe
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
| | - Hassan Mir
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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Galimov A, Vassey J, Galstyan E, Unger JB, Kirkpatrick MG, Allem JP. 'Ice' flavor-related discussions on Twitter: a content analysis (Preprint). J Med Internet Res 2022; 24:e41785. [DOI: 10.2196/41785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/26/2022] [Accepted: 11/09/2022] [Indexed: 11/10/2022] Open
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Ullah A, Liu Y, Wang Y, Gao H, Wang H, Zhang J, Li G. E-Taste: Taste Sensations and Flavors Based on Tongue’s Electrical and Thermal Stimulation. SENSORS 2022; 22:s22134976. [PMID: 35808472 PMCID: PMC9269741 DOI: 10.3390/s22134976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/19/2022] [Accepted: 06/27/2022] [Indexed: 11/16/2022]
Abstract
Taste is a key sense that helps identify different food types and most of this work was carried out on primary tastes rather than generating different flavors. In this work, we proposed a plan to create other flavors rather than primary tastes, adjusted the electrical (40–180 µA) and thermal stimulation (20–38 °C and 38–20 °C), and revealed the digital coding for multi-flavors. Our results showed that different combinations of digital coding could generate different flavors and that tastes related to different stimuli are easy to develop. The novelty of this work is to design other types of flavors and primary tastes. The experimental results demonstrated that the novel method proposed for digital taste coding could realize primary tastes (sweet, sour, salty, spicy, and mint) and mixed flavors. Furthermore, some innovative sensations have been realized, which are sprite, soda water, sweet-sour, salty-sweet, and salty-mint sensations. We presume that this innovation could digitally enhance various flavors.
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Affiliation(s)
- Asif Ullah
- State Key Laboratory of Industrial Control Technology, College of Control Science and Engineering, Zhejiang University, Hangzhou 310027, China; (A.U.); (Y.L.); (H.G.); (H.W.); (G.L.)
| | - Yifan Liu
- State Key Laboratory of Industrial Control Technology, College of Control Science and Engineering, Zhejiang University, Hangzhou 310027, China; (A.U.); (Y.L.); (H.G.); (H.W.); (G.L.)
| | - You Wang
- State Key Laboratory of Industrial Control Technology, College of Control Science and Engineering, Zhejiang University, Hangzhou 310027, China; (A.U.); (Y.L.); (H.G.); (H.W.); (G.L.)
- Correspondence:
| | - Han Gao
- State Key Laboratory of Industrial Control Technology, College of Control Science and Engineering, Zhejiang University, Hangzhou 310027, China; (A.U.); (Y.L.); (H.G.); (H.W.); (G.L.)
| | - Hengyang Wang
- State Key Laboratory of Industrial Control Technology, College of Control Science and Engineering, Zhejiang University, Hangzhou 310027, China; (A.U.); (Y.L.); (H.G.); (H.W.); (G.L.)
| | - Jin Zhang
- School of Computer and Communication Engineering, Changsha University of Science and Technology, Changsha 410114, China;
| | - Guang Li
- State Key Laboratory of Industrial Control Technology, College of Control Science and Engineering, Zhejiang University, Hangzhou 310027, China; (A.U.); (Y.L.); (H.G.); (H.W.); (G.L.)
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